Vegetarian diet planning for adolescents with diabetes

Adolescents with insulin dependent diabetes mellitus (IDDM) who choose to be vegetarian have complex nutritional needs because of their continued physical growth and development, their participation in strenuous activities, and their need to consume sufficient carbohydrates to match their insulin doses. Since diet control is a cornerstone of diabetes management, the adolescent who chooses a vegetarian diet may cause their parents needless anxiety. Nurses working with these adolescents can provide support and guidance and liaison with the endocrinologist, nutritionist or dietitian, and diabetic educator. Although adolescent diabetic vegetarians have not been studied extensively as a population, facts about nutrition and diabetes can be used to assist in meal planning. A complete growth and nutritional assessment must be done to search for any problem areas. If protein dense flesh food is eliminated and a largely carbohydrate diet is consumed, there are additional areas of concern in regulating insulin needs. Blood glucose should be monitored very carefully during diet changes. Vegetarian girls with diabetes also should be carefully monitored for the adequacy of their diet because they may be at risk of developing an eating disorder.     

素食预防2型糖尿病的效果

目的探讨素食预防2型糖尿病的效果。方法采用便利抽样的方法从某社区居民中抽取信仰佛教的素食2年以上者55例及饮食结构以植物性食物和动物性食物混合为主者53例,调查108例研究对象的糖尿病史,并空腹检测血糖及总胆固醇。结果素食组和荤素食混合组的空腹血糖分别为（4.05±0.61）、（4.86±1.61）mmol/L,胆固醇分别为（4.32±1.04）、（5.08±0.85）mmol/L,差异有统计学意义（P〈0.01）;素食组无一例符合糖尿病诊断标准（空腹血糖≥7.0mmol/L）,荤素食混合组有4例空腹血糖≥7.0mmol/L,差异无统计学意义（P=0.055）。结论通过增加膳食中植物性食物的比例,能提高机体对胰岛素的敏感性,降低空腹血糖,而且素食成分有助于维持人体的酸碱平衡、降低体内胆固醇水平,从而控制心血管系统疾病的危险因素。     

Vegetarian lifestyle and monitoring of vitamin B-12 status

Vegetarians are at risk to develop deficiencies of some essential nutrients, especially vitamin B-12 (cobalamin). Cobalamin occurs in substantial amounts only in foods derived from animals and is essential for one-carbon metabolism and cell division. Low nutritional intake of vitamin B-12 may lead to negative balance and, finally, to functional deficiency when tissue stores of vitamin B-12 are depleted. Early diagnosis of vitamin B-12 deficiency seems to be useful because irreversible neurological damages may be prevented by cobalamin substitution.The search for a specific and sensitive test to diagnose vitamin B-12 deficiency is ongoing. Serum vitamin B-12 measurement is a widely applied standard method. However, the test has poor predictive value. Optimal monitoring of cobalamin status in vegetarians should include the measurement of homocysteine (HCY), methylmalonic acid (MMA), and holotranscobalamin II. Vitamin B-12 deficiency can be divided into four stages. In stages I and II, indicated by a low plasma level of holotranscobalamin II, the plasma and cell stores become depleted. Stage III is characterized by increased levels of HCY and MMA in addition to lowered holotranscobalamin II. In stage IV, clinical signs become recognizable like macroovalocytosis, elevated MCV of erythrocytes or lowered haemoglobin. In our investigations, we have found stage III of vitamin B-12 deficiency in over 60% of vegetarians, thus underlining the importance of cobalamin monitoring in this dietary group.     

Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes

OBJECTIVE

We assessed the prevalence of type 2 diabetes in people following different types of vegetarian diets compared with that in nonvegetarians.

RESEARCH DESIGN AND METHODS

The study population comprised 22,434 men and 38,469 women who participated in the Adventist Health Study-2 conducted in 2002–2006. We collected self-reported demographic, anthropometric, medical history, and lifestyle data from Seventh-Day Adventist church members across North America. The type of vegetarian diet was categorized based on a food-frequency questionnaire. We calculated odds ratios (ORs) and 95% CIs using multivariate-adjusted logistic regression.

RESULTS

Mean BMI was lowest in vegans (23.6 kg/m²) and incrementally higher in lacto-ovo vegetarians (25.7 kg/m²), pesco-vegetarians (26.3 kg/m²), semi-vegetarians (27.3 kg/m²), and nonvegetarians (28.8 kg/m²). Prevalence of type 2 diabetes increased from 2.9% in vegans to 7.6% in nonvegetarians; the prevalence was intermediate in participants consuming lacto-ovo (3.2%), pesco (4.8%), or semi-vegetarian (6.1%) diets. After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use, and BMI, vegans (OR 0.51 [95% CI 0.40–0.66]), lacto-ovo vegetarians (0.54 [0.49–0.60]), pesco-vegetarians (0.70 [0.61–0.80]), and semi-vegetarians (0.76 [0.65–0.90]) had a lower risk of type 2 diabetes than nonvegetarians.

CONCLUSIONS

The 5-unit BMI difference between vegans and nonvegetarians indicates a substantial potential of vegetarianism to protect against obesity. Increased conformity to vegetarian diets protected against risk of type 2 diabetes after lifestyle characteristics and BMI were taken into account. Pesco- and semi-vegetarian diets afforded intermediate protection.Vegetarian diets may play a beneficial role in promoting health and preventing obesity (1–3). Vegetarianism encompasses a spectrum of eating patterns: from diets that leave out all animal meats and products (vegan) to diets that include eggs, milk, and milk products (lacto-ovo vegetarian) or even fish in addition to eggs, milk, and milk products (pesco-vegetarian). A previous study has indicated that BMI increases when a wider spectrum of animal products are eaten. Specifically, the European Prospective Investigation found that BMI was highest in meat eaters, lowest in vegans, and intermediate in fish eaters (4). The protective effects of vegetarianism against overweight may be due to avoidance of major food groups, displacement of calories toward food groups that are more satiating (5), or other factors.Based on a review of experimental data, investigators have suggested that the portfolio of foods found in vegetarian diets may carry metabolic advantages for the prevention of type 2 diabetes (6). This notion has been confirmed in observational studies. In the Nurses Health Study, intakes of red meat and processed meats were associated with increased risk of diabetes (7). In a study of Seventh-Day Adventists, diabetes was less prevalent in vegetarian than in nonvegetarian churchgoers (8). Likewise, Fraser reported a lower prevalence of diabetes in vegetarians than in semi- or nonvegetarians (1) and Vang et al. (9) found that processed meat consumption was a risk factor for diabetes. However, these church-based cohorts were initiated in the 1960s–1970s and included primarily non-Hispanic whites. Furthermore, the type of vegetarianism or diabetes was not specified.A pertinent question is whether vegetarian diets remain protective in current obesity-promoting environments and in diverse populations. We studied a Seventh-Day Adventist cohort that included a population of whom ∼25% of subjects were black and that was characterized by vegetarian and nonvegetarian eating patterns. We hypothesized that more exclusively vegetarian diets, e.g., vegan, lacto-ovo, or pesco-vegetarian, are associated with lower prevalence of obesity and type 2 diabetes compared with semi- or nonvegetarian diets.     

Osteoporosis diet

Bone requires a wide variety of nutrients to develop normally and to maintain itself after growth. Most important--in the sense that bony abnormalities are associated with their deficiencies--are protein, calcium, phosphorus, vitamin D, C and K, zinc, manganese and copper. The nutrients most likely to be deficient in citizens of industrialized countries are calcium and vitamin D. In this review of the current literature about nutritional aspects of osteoporosis, we have focused on factors influencing calcium requirement: the principal interacting nutrients are sodium, protein, caffeine, fiber, oxalate, phytate, and the acid/alkaline ash character of the overall diet. Fiber and caffeine decrease calcium absorption from the gut and typically exert relatively minor effects, while sodium, protein and the acid/alkaline balance of the diet increase urinary excretion of calcium and are of much greater significance for the calcium homeostasis. Alkali buffers, whether vegetables or fruits reverse this urinary calcium loss. As long as accompanied by adequate calcium intake, protein-rich diet is not deleterious to bone: a calcium-to-protein ratio of 20:1 (mg calcium/g protein) is recommended. Whether a nutrition-based therapeutic approach to osteoporosis is feasible in the near future is yet unclear: at least there are some recent promising data from in-vitro as well as from rat studies showing that extracts taken from various vegetables, mainly from the onion family inhibit bone resorption in a dose-dependent manner.     

Diabetic diet 2000

Diabetes diet in the year 2000 consists essentially of carbohydrates. 50% to 60% of the total caloric intake has to be taken in form of carbohydrate. Slowly metabolised forms of carbohydrate should be preferred. Fat and proteins should not exceed more than 20% of the respective total caloric intake. Vegetable fats should be preferred compared to animal fats. Patients with type 2 diabetes who should loose weight have to be extremely careful regarding the fat intake. Insulin-dependent diabetics can correct mistakes in the carbohydrate intake by injecting fast insulins provided that they have in-depth knowledge of the mode of action of insulin and dietary experience.     

The salt-free diet

The debate about the importance of salt in the pathogenesis and treatment of hypertension is still ongoing. The importance of salt is rooted on several factors. First, salt is one of the first factors who has been identified to be of potential importance in blood pressure regulation. Second, during the last decades several other pathogenetic risk factors for essential hypertension have been identified, however, without the identification of one single predominant risk factor. These risk factors include different genetic factors and predispositions as well as modifiable environmental factors. For the development of hypertension usually several of these risk factors have to be present. In miscellaneous disease conditions, such as heart failure, salt induces a sodium and volume retention. Accordingly it is often falsely concluded that salt will lead to a volume retention and hypertension in all subjects and that a salt restriction will lead to a normalization of an elevated blood pressure. Although about 40% of the patients with essential hypertension are salt sensitive, the concept of salt sensitivity is not valid for all subjects of a population. Accordingly one can not conclude that a general salt restriction would be a cure for hypertension. The therapeutic priority in the non-pharmacological prevention and/or therapy of hypertension lies usually in the control of other risk factors than salt intake. These risks include overweight and obesity, alcohol consumption and physical inactivity. These concepts are supported by several recent meta-analysis.